Osteoarthritis Health Promotion (II) Wang Linqing, Department of Orthopedics, Lanzhou Hospital of Traditional Chinese Medicine and Orthopedic Surgery
What means can help detect osteoarthritis?
X-rays are a form of electromagnetic radiation (such as light) that is high in energy and can penetrate the body to form an image. Structures that are dense (such as bones) will appear white, air will be black, and other structures will have different shades of gray in density. X-rays can reveal: narrowing of the osteoarticular space; abnormal increases in bone density; bone cysts or bone defects.
MRI is a much clearer examination of the joint and can clearly show the cartilage in the joint, the presence of joint effusion, and soft tissue visualization such as the muscles and tendons around the joint.
Will osteoarthritis ever get better?
Osteoarthritis is not life-threatening, but the pain and stiffness of the joints can seriously affect the quality of life, daily activities, and mental health of patients. Five percent of people with osteoarthritis change jobs because of the disease. Without medication or surgery to reduce symptoms, osteoarthritis may continue to progress. The disease is not completely curable and is irreversible. But there are many treatments that can relieve symptoms and improve quality of life.
Lifestyle changes: Doctors recommend lifestyle changes to reduce the weight on the joints. Physical therapy and bracing can be effective in relieving symptoms. Active patient education can increase awareness of the disease and reduce the number of visits to the doctor.
Work changes: Once osteoarthritis is diagnosed, patients should reduce the amount of impact on damaged joints. If the patient’s job involves repetitive, high-intensity joint activities, care needs to be taken to avoid joint trauma. If necessary, consider changing the work environment or changing jobs to reduce stress on the joints.
Activity and exercise: Joints need to be active to maintain health. Prolonged braking can lead to joint stiffness and atrophy of the surrounding tissues. Moderate-intensity activities such as low-intensity aerobics and strength exercises can be beneficial for people with osteoarthritis and may even slow the progression of the disease. These exercises can reduce joint stiffness, increase joint mobility, and strengthen the joint and knee cartilage, enhancing balance and endurance. In addition, it can help to reduce the emotional stress associated with pain. Moderate exercise is particularly effective for patients with moderate to severe hip or knee osteoarthritis. When patients begin aerobic exercise they find pain relief and better joint mobility. They were able to perform daily chores better and were more independent than their peers. Geriatric patients need to consult with their physicians before starting to exercise. Some simple but practical ways to train for osteoarthritis are described later.
How to treat osteoarthritis?
Early, timely, appropriate and regular treatment is the key to improving osteoarthritis. Although osteoarthritis cannot be cured, early and aggressive treatment can reduce pain, slow the progression of the disease, improve joint function, and prevent disability. In the early stage, medication, functional rehabilitation and physical therapy can be used, while in the late stage, a combination of multiple treatments can be used, and in severe cases, surgery can be used.
Drug therapy
According to the recommendations of the International League of Rheumatology (ILAR) and the World Health Organization (WHO), the drugs currently used to treat osteoarthritis are divided into two categories: non-specific drugs and specific drugs.
Non-specific drugs, also known as “symptom control drugs”. These drugs can provide quicker pain relief and improve symptoms, but the improvement of the disease itself is not obvious.
1. Anti-inflammatory and pain-relieving drugs (non-steroidal and steroidal).
Non-steroidal anti-inflammatory drugs (NSAIDs): these drugs that have analgesic effect also have anti-inflammatory effect, but not all NSAIDs class of drugs are effective for osteoarthritis, such as indomethacin, aspirin, etc., have an inhibitory effect on cartilage matrix synthesis, long-term use will instead aggravate the lesions of osteoarthritis. The analgesic effect of acetaminophen is more obvious, but adverse reactions such as gastrointestinal irritation can cause certain consequences and should not be used for a long time. Selective COX-2 receptor inhibitors, such as celecoxib and etoricoxib, are relatively light on the gastrointestinal tract and are suitable for long-term analgesic options. Because osteoarthritis occurs mostly in the elderly, patients need to use with caution and follow medical advice when there is stomach discomfort, or a history of bleeding peptic ulcers, taking anticoagulants, or the presence of other chronic diseases.
Hormones, steroids: When the pain is significant and the symptoms are not relieved by common medications, intra-articular steroid hormone injections can be received for a period of 3 months and are only used during the inflammatory phase of the joint and are not considered for oral or systemic use. The drug can only provide short-term relief of inflammation and pain and is not suitable for long-term treatment and should not be overused. Considering the side effects of long-term use, patients are advised not to take more than 2-3 doses per year and need to be under medical supervision. Women are more sensitive to the drug.
2. Narcotic painkillers: If severe osteoarthritis causes pain and conventional pain medication is ineffective, narcotic painkillers such as tramadol, oxycodone or morphine may also be considered. However, the side effects of these drugs are more obvious and must be used under the guidance of a physician, do not abuse.
3. Capsaicin and topical drugs related to Chinese medicine: Capsaicin is extracted from the ripe fruit of chili peppers, which can inhibit the body’s pain transmitter (substance P), thus achieving analgesic effects. In contrast, traditional Chinese herbal poultices are mainly used to relieve pain by activating blood circulation and removing blood stasis. Although topical drugs do not stimulate the gastrointestinal tract, they can easily cause local allergy, redness, swelling, burning discomfort and other symptoms, and in severe cases, they may cause skin breakdown.
Atopic drugs, also known as condition improving drugs. These include glucosamine and hyaluronic acid. These drugs are slow to work, but have a cartilage-protective effect, slowing and stabilizing cartilage degradation in osteoarthritis.
1. Glucosamine and chondroitin: Glucosamine and chondroitin sulfate are the main components that make up cartilage and perichondral tissue and are found in normal human joint cartilage. They have been commonly used in Europe for the past 10 years to relieve pain and improve joint mobility in osteoarthritis. a clinical study published in the New England Journal of Medicine in 2006, showed significant relief of knee pain in most patients with the combination of a COX-2 receptor inhibitor (celecoxib) and either glucosamine or chondroitin. Glucosamine is a physiologically active substance that is normally synthesized by the body itself in sufficient amounts to form proteoglycans that build cartilage structures. When cartilage is diseased, the body does not synthesize enough glucosamine on its own and needs to supplement it with exogenous glucosamine. Studies have confirmed that exogenous supplementation of glucosamine specifically acts on articular cartilage to target the insufficient synthesis of proteoglycans in osteoarthritic cartilage and exert a therapeutic effect. Since the substance is physiological in nature, it is safe and less irritating to the gastrointestinal tract, making it suitable for long-term use. It is usually taken continuously for 4-12 weeks and the treatment is repeated 2-3 times a year.
2. Hyaluronic acid: Intra-articular injection of hyaluronic acid is also a recommended method for the treatment of osteoarthritis. Hyaluronic acid is a natural substance that reduces joint friction and vibration. Large doses of hyaluronic acid also have anti-inflammatory effects. Patients can have hyaluronic acid injections once a week for 3-5 weeks. The drug needs to be used in the joint and needs to be administered by a physician at a hospital by injection. Because hyaluronic acid is viscous, a large needle is required and anesthetic medication is added to relieve pain. Forty-eight hours after each injection, the patient needs to reduce weight-bearing activities. Hyaluronic acid analgesia is as effective as NSAIDs and steroids, and there are no gastrointestinal adverse effects. One study found that 39%-56% of patients who received one course of treatment had no significant pain under weight bearing for 24 weeks. After receiving two courses of treatment, 87% of knee symptoms were significantly better.
[Rehabilitation conservative treatment].
1. Functional training: In addition to exercise, exercises that target the muscles and joints are also important. In our study, we found that patients with general exercises combined with physical therapy had 30-40% improvement in symptoms after 2-4 follow-up sessions. Some simple methods of muscle strength and stretching exercises will be described later.
2. Weight loss: Patients with osteoarthritis can lose weight to reduce the impact of their weight on the joint. For the knee joint, the knee joint is subjected to 3-5 times its weight when descending stairs. Losing 5 pounds can reduce the impact by 20 pounds. Therefore, weight control can be helpful in both prevention and treatment of osteoarthritis.
3. Heat and ice packs
Ice: In acute attacks of osteoarthritis (especially in the knee), ice packs for 10-15 minutes can be effective. If you cannot find an ice pack, a packet of frozen vegetables or beans works just as well. Treatment regarding acute symptom attacks.
Hot compresses: Patients can soak their osteoarthritic hands in hot water to relieve pain; heating pads can treat osteoarthritis of the hip joint. But changing the ambient temperature doesn’t seem to make much of a difference. According to one study, people who live in warm areas are more sensitive to changes in ambient temperature than those who live in cold, wet areas.
4. Hydrotherapy: is an ancient treatment method that uses mineral baths to reduce pain. Although many studies have confirmed that the method can improve quality of life, few people strictly implement it.
5. Equipment and exercise training.
Stationary bicycle: Most patients can use this treatment by acquiring a stationary bicycle at home and following a fitness program with appropriate adjustments: e.g., adjusting the bicycle seat higher to reduce extreme knee extension and flexion; horizontal bicycle, for patients suffering from low back pain
Treadmill: Some patients with osteoarthritis cannot practice on the treadmill, even if the low-intensity exercises can cause damage to the joints. However, for those who can tolerate the impact of the treadmill, treadmill exercises can be used as home exercises.
Swimming: The Osteoarthritis Association has long supported this exercise because it is easily accepted by patients and has evidence of its effectiveness for osteoarthritis recovery. However, swimming is not suitable for all patients and should be done according to ability.
6. Braces and supports: A variety of braces and supports are available to support and protect joints, help coordinate joints and distribute weight appropriately. The most common are braces for arthritis of the hands, wrists, back, knees, ankles and toes. These braces restrict the damaged joint to a certain range of motion and do not restrict nearby joints. They are usually made of lightweight metal, leather, elastic, foam, plastic malleable and easy to use nylon straps. Use a brace or orthotic custom splint under the direction of a physical therapist or specialist. Improper or inappropriate use of orthotics can do more harm than good.
7. Elastic tape, adhesive support tapes and intramuscular patches: Using soft support tapes such as elastic tape to protect the affected joint provides a better fit and comfort than rigid braces. For example, wrapping bandages with specific therapeutic sway around the knee joint may be effective for the joint. In one trial, it was found that 40% of patients felt less pain after a few days of treatment. The pain continued to decrease after 3 weeks of use. 8.
8. Other protective measures: shock-absorbing shoes or orthopedic soles can be worn during daily activities or moderate exercise. Neck brace and lumbar brace can reduce neck and back pain; hard mattress proves effective in relieving back pain. For patients with progressive osteoarthritis, it is necessary to use crutches and canes to assist with walking.
[Surgical treatment
Different surgeries are used for different conditions of patients suffering from osteoarthritis in order to relieve pain and improve joint function. If medication does not work, surgery should be considered. But even so, the possibility of future joint replacement cannot be ruled out. Joint replacement is the ultimate treatment for osteoarthritis.
1.Arthroscopic surgery
With the rise of minimally invasive arthroscopic surgery, arthroscopic surgery can provide less surgical trauma, faster post-operative recovery, and better tolerance of the surgery. Arthroscopic treatment of osteoarthritis allows for a comprehensive cleaning of the joint, mainly removing tissue debris that causes pain and inflammation; clearing synovial membranes that tend to produce fluid and swelling; cleaning broken articular cartilage and meniscus; and grinding the bone growths in the joint to relieve symptoms. This type of arthroscopic surgery is performed in 650,000 cases each year in the United States, and half of the patients experience relief from pain and other symptoms after the procedure.
Although arthroscopic surgery cannot completely cure osteoarthritis, it is effective in relieving symptoms, controlling the disease, and slowing the progression of osteoarthritis. The procedure is less invasive, quicker to recover, and less expensive than joint replacement. Usually the hospital stay is only 1-2 days, and you can rehabilitate and even walk on the ground the day after surgery.
2.Joint replacement
When osteoarthritis becomes more serious and affects normal function, joint replacement is considered. Hip joint replacement is the most effective and most efficient surgical method, followed by knee joint. However, long-term results are better for the knee than for the hip. Surgery on other joints such as the shoulder, elbow and finger joints is less commonly performed, and spinal arthritis is generally not treated in this way.
When there is severe pain, severe limitation of movement such as inability to walk, and conservative treatment has not worked, the need for arthroplasty should be considered. However, some experts recommend that joint replacement be performed sooner rather than later because when the disease is very severe, the patient may not regain full function.
Unicondylar knee replacement: Unicondylar replacement may be considered when the knee injury is relatively limited. This procedure is recommended for non-obese patients over the age of 60 and provides pain relief and delays total knee replacement. A small incision is made and an implant is placed, preserving the ligaments of the knee and allowing more joint mobility than with a total knee replacement. The surgery time, trauma and cost are better than total knee replacement.
3, other surgical methods: including osteotomy, joint fusion, arthroplasty, etc., but is no longer the first choice for the treatment of osteoarthritis, the application is less.
What should I pay attention to in terms of nutrition for osteoarthritis patients?
1. Phytonutrients: A large study reported that when patients with osteoarthritis took saponins extracted from avocados and soybeans, they experienced significant symptom relief. The study noted that while the ingredient did not relieve hip pain, it did slow joint degeneration. Another component of soy, isoflavones, also reduces bone loss. 2.
2. fish oil and omega-3 fatty acids: omega-3 fatty acids, found in fish oil, canola oil, blackcurrant, evening primrose seed oil and flax seed, have anti-inflammatory components and protect cartilage.
3. vitamin B3: Some studies have found that vitamin B3 is beneficial for people with osteoarthritis.
4. Calcium and vitamin D: Calcium and vitamin D are important for bone quality. Although osteoarthritis is a joint disease, it is also important for older adults to maintain bone mass and bone mass.
Experts recommend that adults need a daily supplement of 1000mg of calcium and adolescents need 1200-1500mg of calcium daily. Postmenopausal women who are pregnant without estrogen therapy and patients receiving hormone therapy need to supplement with 1500mg of calcium/day. Women who are breastfeeding need to supplement with 2000mg of calcium/day. Calcium supplementation may increase the risk of kidney stones when supplemented, so calcium supplementation should not exceed 2500mg per day.
As a standard, normal adults generally take 400 units of vitamin D supplementation per day and 600 units over 60 years of age. People with insufficient sun exposure and inadequate nutrition may have insufficient vitamin D. Good dietary sources of vitamin D include fortified milk, sardines, herring, salmon, tuna, liver, dairy products, and egg yolks. However, it is important to note that too much vitamin D can be toxic, so you should not exceed the daily intake of 1200 units.
5. Selenium: is a trace element found in grains, nuts, vegetables, and some meats and seafood. Preliminary studies have shown that not getting enough selenium in the diet makes you more likely to develop osteoarthritis of the knee. Selenium supplements are being studied to see if they can help prevent arthritis or prevent progression.
[Chinese Orthopedic Sports Medicine Network Fudan University Sports Medicine Center]
Reprinted from: Sports Medicine Center of Fudan University China Orthopedic Sports Medicine Network